No pregnant woman is immune from various complications. She can learn about them at different times in her “interesting” position. One of these diagnoses that darkens the mood of the expectant mother may be low placentation. What is it, is it possible to recognize this condition before an ultrasound scan, what to do to maintain pregnancy and how the birth will proceed - we will give answers to these questions.
What is low placentation?
The placenta is an organ necessary for the development and successful gestation of the fetus. It is formed in the uterus. Through the circulatory system of the placenta, the embryo receives nutrients and oxygen. When is the placenta formed? The initial stage of this process begins closer to the seventh day after conception. During this period, the placenta precursor, the outer membrane, develops around the fetus. The process of its formation is completed by the 20th week of pregnancy. The course of pregnancy and childbirth depends on the placenta’s attachment to the wall of the uterus. Ideally, the placenta is attached at the highest point inside the uterus: there are better conditions for the development of the embryo and excellent blood flow. But often a pregnant woman is diagnosed with a low-lying placenta. This is low placentation. In this condition, the embryo is attached closer to the exit of the uterus (throat) closer than 5.5-6 cm.
How should the embryo (fetus) normally be located in the uterus at different stages of pregnancy?
A few days after conception, the embryo descends into the uterine cavity and attaches to the endometrial layer of the uterine wall. Normally, this occurs closer to the bottom of the organ - the upper convex part, which protrudes above the line of connection with the uterus of the fallopian tubes.
In the second trimester, the fetus begins to move. It can change its location in the womb. The position of the fetus relative to the cervix is called presentation.
By the end of the third trimester, before birth, the fetus takes the position in which it will pass through the birth canal. Its head descends lower to the cervix and presses against the entrance to the pelvis. A cephalic presentation is considered normal, in which the baby’s head is positioned towards the exit. Pelvic, transverse and oblique presentation are pathologies, with the latter two a cesarean section is indicated.
Causes of low placental attachment
Why is the placenta low? There are many reasons. Conventionally, they are divided into congenital and acquired - due to previous illnesses, operations, abortions. Reasons for low placental attachment include:
- anomaly in the development of the internal genital organs of a woman;
- age over 30 years;
- inflammatory diseases of the uterine mucosa and pelvic organs;
- presence of sexually transmitted diseases;
- previous surgeries on the reproductive organs;
- neoplasms in the uterus;
- multiple pregnancy;
- a large number of births;
- childbirth with bleeding and separation of the placenta;
- artificial termination of pregnancy (abortion)
How dangerous is the situation for mother and child?
The low position of the fetal head or other parts of it (usually the buttocks and legs) leads to additional pressure on the lower segment of the uterus and cervix. As a result of this, the following may occur:
- the tone of the uterus increases primarily or secondarily;
- The cervical canal may open, which provokes the rupture of amniotic fluid.
As a result, premature birth may occur. The consequences for the mother are usually minimal. Such early births are dangerous for the child: the immaturity of all systems and organs threatens his life after birth, a high percentage of disability, and serious health problems in the future.
In some cases, a woman can undergo and successfully carry a pregnancy, having a low position of the child in the womb. However, until the 37th week she still faces the risk of giving birth to a premature baby.
The danger of low placentation for pregnancy
If the placenta is descended, the fetus puts pressure on it as it grows. This can lead to bleeding and placental abruption. The latter is a serious threat not only to the life of the unborn baby, but also to the life of the pregnant woman.
Another thing low placentation threatens is the threat of miscarriage and other complications. As the fetus grows, the placenta moves. With low placentation along the anterior wall, it is possible that the umbilical cord may become entangled and the exit from the uterus may be blocked.
If a pregnant woman has low placentation along the posterior wall, there may be more complications. Subjectively, a woman may feel pressure in the lower abdomen and complain of pain, which will intensify as the fetus grows. Since there are few blood vessels in the lower part of the uterus, due to a prolapsed placenta, the fetus may not receive enough oxygen and nutrients.
In what case is it considered that the baby is located low?
When do doctors talk about low placentation and the location of the baby? If in the second trimester the placenta is attached at a distance of less than 7 cm from the internal os of the uterus, and in the third trimester - less than 5 cm, then placentation is considered low.
Is it possible to independently determine how the baby is positioned in the womb? A woman may experience characteristic symptoms:
- aching pain in the lower abdomen;
- bloody, spotting discharge;
- problems with stool;
- bloating.
However, these symptoms only allow one to suspect that the fetus lies at the internal os. Diagnosis is made during a gynecological examination, during which the doctor can assess the distance between the fetus and the cervix. The diagnosis can be confirmed using ultrasound.
Central (complete) placenta previa
This is a more serious diagnosis than low placentation in pregnant women.
With central presentation, the placenta is located at the bottom of the uterus, blocking the exit from it. There is also partial presentation - marginal and lateral. In the first case, the placental tissue covers two-thirds of the exit from the uterus, in the second - no more than a third of its pharynx. In case of central placenta previa, delivery is carried out by caesarean section.
Can a child get up and what to do in this situation?
If, during an examination by a gynecologist, it was discovered that the fetal head is low, do not panic, because the baby can still rise. To do this, you should follow the following recommendations from doctors:
- Limiting physical activity. A woman should stop playing sports and avoid physical labor. The maximum permissible activity is leisurely walking. Also, the expectant mother should give up heels and choose comfortable, loose clothing.
- Sexual abstinence. There is no strict ban on intimate life, but penetrative sexual contact should be avoided. During sexual intercourse, there is an additional impact on the cervix, which can lead to its premature dilatation.
- Wearing a bandage. It is recommended to wear the bandage starting from the 20th week. It can be purchased at any pharmacy and in specialized stores and departments for pregnant women.
If the fetus is located low, constant monitoring by a gynecologist is necessary. Neglecting the doctor's recommendations can lead to disastrous consequences for the child.
Treatment for low placenta
There is no treatment for this condition. There are only guidelines to follow. In any case, it is better to take care of yourself and your unborn baby. With low placentation you need:
- exclude serious physical activity;
- get enough sleep and plenty of rest;
- eat right so that the child receives the right amount of vitamins;
- consult a doctor if something bothers you;
- stay calm;
- when sleeping, place a pillow under your feet - they should be above the level of the pelvis;
- temporarily give up intimate life;
- go to the hospital if the placenta has not risen by 36 weeks.
Why is it dangerous for a baby to be in a low position at different stages?
In itself, this situation is not a pathology; it is dangerous only in combination with other symptoms - increased myometrial tone and a shortened cervix (up to 2 cm). In this case, the pregnant woman is constantly monitored, she visits the gynecologist more often than others and has an ultrasound scan.
If the baby's head is very close to the internal os, and this is accompanied by pathology of the cervix, this condition can provoke a miscarriage. In a hospital setting, the woman’s cervix is sutured or a special support ring is placed - an obstetric pessary (for more details, see the article: obstetric pessary: what is it and why is it placed?).
When the baby drops early, at 32–33 weeks, the head puts a lot of pressure on the internal organs. This can lead to exacerbation of hemorrhoids in a woman.
With low placentation, the likelihood of placental abruption and uterine bleeding increases. The child is at constant risk of oxygen starvation.
Stem cells can be used to treat both the child and his relatives
Today, stem cell treatment methods are successfully used all over the world. In Ukraine, the leading position in the development and application of such techniques belongs to the Institute of Cell Therapy. Cord blood stem cells are stored in the Cryobank of the Institute of Cell Therapy in special containers under guaranteed maintenance of the necessary conditions.
Other methods of maintaining pregnancy
Depending on the period at which the low location was detected, the condition of the cervix and the woman’s complaints, the following treatment options are possible:
- Bed rest . This is the most common and simple recommendation for women. If the position of the child is very low and there are structural changes in the cervix, strict bed rest is prescribed. You can only go up to the toilet, eat and shower. In a horizontal position, the presenting part of the fetus does not exert such strong pressure on the lower segment as in a vertical position. This helps maintain pregnancy.
- Installation of a pessary (abbreviated as RAP - unloading obstetric pessary). This ring for the cervix can be hard plastic, silicone, of various sizes (selected based on the anatomy of the woman’s genital organs).
- After installing the pessary, pressure from the presenting part of the fetus is applied not only to the cervix, but also to the entire surface of the product. This slows down structural changes in the cervix, helping to maintain pregnancy. Can be installed at any time up to the 32-35th week if necessary.
- Suture on the cervix . Apply at a period of 16 to 20-22 weeks. It is used for isthmic-cervical insufficiency, in which case the presenting part of the fetus may also be low. It is a circular suture in the area of the internal pharynx, which literally prevents the cervix from opening even with pressure on it from the fetus. Apply only in hospital settings.
If, after examining a doctor and establishing the fact that the baby is low, the threat of premature birth is confirmed, in addition to the above, additional conservative therapy is carried out. It includes the following (sometimes several points at the same time):
- magnesium therapy: magnesium solution is dripped intravenously for up to 10-12 days;
- antispasmodic treatment: drugs such as “No-shpa”, “Papaverine”, “Drotaverine” are used according to an individual regimen;
- tocolytic therapy: Ginipral is used in the form of intravenous injections or tablets for oral administration; it relieves the tone of the uterus and thus helps maintain pregnancy.
We recommend reading about the causes of obstetric bleeding at different stages of pregnancy. From the article you will learn about the classification of obstetric hemorrhage, first aid for massive bleeding, treatment and prevention of obstetric hemorrhage.
And here is more information about what abnormalities of the placenta and umbilical cord may be.
A low position of the baby in the uterine cavity can result in premature birth. Therefore, if a condition is detected or suspected, it is necessary to consult a doctor for qualified medical care, which will primarily be aimed at maintaining the pregnancy. Options and methods of therapy are selected individually, based on the timing and clinical situation.
Why is it worth saving cord blood in Cryobank?
Today, more than 100 diseases can be cured using stem cells. The procedure for collecting umbilical cord blood is possible only at the birth of a child - at the moment of cutting the umbilical cord.
It is absolutely safe and painless for both the child and the mother in labor. When the days are counting, and there is no way to urgently find a suitable donor, then the only way out is treatment with stem cells. While searching for a donor takes months, preparing stem cells takes several hours.
A feeling of maximum peace of mind for the most valuable thing in life - for your children - is only possible if you are 100% sure that the right medicine is at hand. It is stored in the Cryobank of the Institute of Cell Therapy and is available to you and your family upon request.
placenta
How a bandage will help
A bandage for a low-lying fetus is not a treatment, it is just one of the possible measures to prevent premature birth and further lowering of the child. It is especially important to use it in the following cases:
- with a low position of the fetal head (pelvis) after 35-36 weeks;
- during multiple pregnancy.
You can use a universal pre- and postpartum bandage. It must be selected according to size, removed at night and when in a horizontal position.
In other cases, in addition to the bandage, additional treatment is necessary.
Watch this video about how to wear a prenatal bandage correctly and for what purpose:
